Episode I: The Phantom Bolus

Don’t worry – Jar Jar won’t be making an appearance. But this pump quirk is probably just as scary… or annoying.

This was my early Sunday morning…

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I treated an awful 46 mg/dl at around 5:30 am with a crap ton of juice and a graham cracker. I didn’t offer a bolus for the extra snack because I was exhausted and just didn’t care at that point. I’d just deal with it in morning. I didn’t have my transmitter on, so I wanted to take advantage of this uninterrupted sleep for the next couple hours.

I woke up about an hour and a half later because the cats were going crazy. I figured then would be a good time to check again and assess the damage. 192 mg/dl. Not great, but not horrible. Especially for a BG in the 40s. I go to administer a correction for the 192, which should have popped up a 2 unit correction bolus, at least.

It told me to administer .7 units. What?

It also told me that I had 1.3 units already in my system. WHAT?

I scroll to my bolus history and find the following:

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So about an hour after my low, I administered a 1.3 unit bolus for a blood sugar of 164. Which I don’t have record of on my meter. And 164 is a pretty specific blood sugar, so it’s not like I was like oh – I accidentally rolled over onto my bolus button and hit the up arrows. I would have physically had to enter that number in.

Did I just sleep bolus? Did this randomly just show up on my history? Why would I still be 192 a half hour later?

So I did something even more stupid and gave another unit of insulin because I was convinced that I didn’t actually get the full correction that I needed.

And apparently, I didn’t because I woke up about 2.5 hours later with a BG of 99. Excellent.

But – um. WTF?

Random Number Generator

Or… How I felt about my glucose monitor last night.

Don’t get me wrong… I’ve had hypoglycemic episodes during my dance lessons before. My instructor is all too aware of the different sounds my insulin pump makes. (Though… Apparently he heard a new one last night… The temp basal/hour change alarm.) More often than not, he hears the alarms before I do. With that in mind, I consider him to be an honorary member of my broken pancreas club; mostly because he’s around me when my sugars drop the fastest – during exercise post-dinner.

Last night was a pretty traditional trend. I had a dinner that I may have blouses too aggressively on, my CGM reading was around 102 an hour after I ate, and I was headed into samba rehearsal. To be on the safe side because I felt a drop coming, I tested.

49.

Huh.

I went into treatment mode immediately. But paused because I didn’t “feel 49.” So I checked again while knocking down a Juicebox.

76.

And because third time’s a charm, 74.

So… I was probably closer to the 70s after all. Finished the Box, set a small temp basal, and went on my merry way.

Half way through the lesson, my low alarm goes off.

“Do you need to take care of that?” He asks.

“No, I already did. It’s just a residual alarm.”

“Oooookay.”

<10 minutes later>

“Yeah, I’m gonna go test again… Sigh.”

Meter: “52!”

Me: <facepalm>…What happened to that last Juicebox?

My CGM graph is trending downward into the 60s and I finally start feeling the low to the point of disorientation. But, I’ve treated said low, so I should be fine to run my routine at nearly full speed.

Ha.

I nearly toppled over half way through. Hyperventilation, ghostly pale… just… an ugly ugly low. Needless to say, my lesson was over for the night.

The question still remains – what exactly was my starting blood sugar? I’m still not really sure.

Have I mentioned Strip Safely before? Yes? http://www.stripsafely.com/

I know – Congress is a wee bit backed up right now, so sending letters right this second is probably not going to do much good. But when we have a Federal Government again, jump back on this campaign. Do it for me, the zillions of other PWDs and their allies that see them go through this.

Weekend Wrap Up

It’s Monday. I didn’t do a Friday Five last week, so here is a Monday Five instead.

1) I hit a new low this weekend. As in – 28 mg/dl. In the middle of the night. What I can’t figure out is how I got there in the first place (or how I was coherent enough to pour myself a glass of OJ and take on my entire pantry. I didn’t have my CGM on because I was over at a friend’s house enjoying a girls night with lots of high carb options and desserts. (So I didn’t want to have to deal with an inaccurate new sensor.) I left the party with a 191 BG and my pump instructed me to give a 1 unit correction at around 11:15 pm. I didn’t think to check again before I went to sleep at midnight. (Why?) At around 1:45 am – I woke up hungry and got my new low. At first I was like, oh! I should eat something. But then I was like, no… that can’t be right. So I checked again. Still 28. Oy.

2) Diabetes Dancer Problem #48: I somehow managed to hip check my ballroom instructor with my insulin pump during a lesson this weekend. I don’t normally wear my pump clipped to my pants for dancing, but this particular pair required it. I also managed to step on my big toe with my own 2.5 inch Latin heel, which also wasn’t fun. So now my toe (and a little piece of my ego) is bruised.

3) Have you signed our awesome FDA Petition yet? We apparently only need 500+ signatures to ask the FDA to include all PWDs in their upcoming patient meetings. Fire up your SPAM email address and sign here: http://www.change.org/petitions/us-food-and-drug-administration-sponsor-a-patient-meeting-on-diabetes?q=petition. It helps you… it helps me… it helps people I know with Type 1, 2, 1.5, and GD.

4) My swing instructor announced that he and his girlfriend got engaged (in PARIS on the freakin’ lock bridge) this morning/last night. I was so excited that the news woke me up faster than the crap cup of coffee I was drinking.

5) I encouraged the hubby to find a new hobby, as cooking and running can only really be done at certain parts of the day out here. So – he took up home based beer brewing. The first attempt didn’t go so hot and my whole house smelled like barley and hops when I got home from my evening shindig. The second attempt may have gone better and it’s now fermenting for the next two weeks in our guest bathtub. I guess it’s working because the canister is making all sorts of rude noises from behind the shower curtain as the yeast explodes into chocolate stout goodness. We’ll see what happens in two weeks when we get to bottle it.

Wish I Were Here… Mostly

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So, in true Jen fashion, I didn’t exactly sit on my ass all weekend. The hubs and I accepted a last minute invite to spend time in Lake Tahoe. Some friends of mine own a cabin with a fantastic view, tucked away near the middle of nowhere. (Sort of… we still had cell phone reception.) A number of other friends were invited up to enjoy a weekend away, complete with hikes, star gazing on the deck, home cooked meals, and a trip to the beach/lake.

My weekend wasn’t complete without diabetes drama. I spent most of Saturday night battling lows on three separate wake ups in the wee hours of the morn. The odd thing was that I’d set a temp basal and treat the low and my sugars would start to rise safely. As soon as the temp basal was complete, I’d fall into the 50s again. On the third wake up, I turned my basal rate down a notch and ate a full snack without insulin to just get my sugars safely to the morning. This wouldn’t have caused as dramatic of a jump, but my cannula kinked some time between the 46 mg/dl, the basal change, and the morning.

Lots of over-correction, a set change, 2 injections, and a light brunch = 67 mg/dl two hours later. And then… ahh… stability! Finally.

There were some nice points of the weekend, of course. Like munching on snacks all Saturday afternoon and not breaking 200. Or enjoying a nearly carb free dinner and not dropping into oblivion. And of course, catching a couple shooting stars passing overhead, seeing the Milky Way, Venus and Saturn, and listening to some poor sap struggle with playing a tuba on the beach. (Yeah, we didn’t understand it either.)

And since today’s workday was a bummer, I really want to go back.

Saturday DOC Poll

Because I’m insanely curious…

I posted this question on Twitter and didn’t get much response. Probably because Twitter can be a huge black hole sometimes.

But really, what do you do? I’m all about keeping good hygiene, even at 3 am. Plus, waking up with a sour taste in your mouth just sucks.

However, as a young child and was a pro at drinking juice in my sleep via straw, my parents used to just give me water to wash down. Later in life, I’ve had a number of issues with the enamel in my teeth thinning, but I’m not sure if that’s an exposure to OJ acids problem, or a diabetes problem. (Because if I have diabetes, clearly that’s the root cause of EVERYTHING wrong with me, right?)

3p1jpi

Waltz Tango Foxtrot

Yeah, that’s right… it’s a “WTF?!” post. Slightly delayed because I suddenly have no more free time and I haven’t figured out if I can blog at my desk at work yet. Probably not worth the risk.

Anyway, so – I’m still here. Barely. I’ve kicked into dance training overdrive because 1) the studio is closing in 2 months and I want to spend every last cent I can before it does and 2) I got some wild idea that I should pull out of competitive ballroom retirement and head to the International Grand Ball in July. Oh yeah, I’m also still working at the studio and trying to have a kid. Nooooo… I’m not busy at all.

My blood sugars do NOT like this activity overload. Every single class or lesson with my instructor I’ve had this week has either started, or ended, with me chugging a juice box. Or scarfing down chalk tablets glucose tablets. Yeah – even the Gluco-lift ones taste like crap after so many. And then they revolt by joining forces with my Dawn Effect and shoot my fasting blood sugars up to 170+. My docs aren’t going to like this one. And I’m not all that eager to get my A1C checked because it’s not going to be an accurate representation of how I’m really doing.

So I’m looking for alternatives for my lows because I can’t really seem to avoid them at this point until my CDE calls me back with a solution. (In her defence, I just uploaded everything to CareLink today.)

Right now, I treat lows with:
– 4 oz of juice or a juice box. (Junior Juices are hilarious, but exactly 15 g.)
– Gluco-lift tabs
– Target glucose tabs (gross!)
– Dex Gel (a new discovery… not that bad actually.)
-Fruit snacks

Name some other portable methods you use. In theory, ones that don’t require me to think during hypos (I’m not counting out 20 Skittles), ones that fit in my purse and won’t leak everywhere (hi honey and other syrupy substances…), and ones that won’t melt, spoil, etc. if exposed to the elements (our back office at the studio isn’t insulated).

Oh My Lantus…

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My pharmacy’s EXACT count of a 30-day supply of syringes. Those cheap bastards.

 

Normally, I’m an advocate for taking “vacations” from the insulin pumps and now, CGM every now and then. Being tethered to something 24/7 can feel daunting and a bit draining after a while. And if the resources present itself, going on shots for a little bit probably won’t hurt thee ol’ A1C much.

I take it all back.

I’ve been back on Lantus for 2 days now and I really want my pump back. I know that the Lantus will work out better for me over the weekend, but shit, I’m having a rough time.

My CDE recommended a Lantus dosage similar to my TDB (total daily basal) amount. I am on over 14 units of basal per day, but of course it’s not a nice neat number for my syringes. I took 14 units back in January when my pump fried unexpectedly and it was manageable. But since I’ve bumped up my rates a bit on my pump, CDE suggested heading up to 15 units of Lantus for the days I wasn’t as active and then dropping to 14 on my show dates.

I tried 14 units on my first day and it was okay. A few 70s here and there, but I think mostly because I was over-doing my meal injections. I figured I could bump up slightly to about 14.5-ish units so I could have more support throughout the day. (Still saw some post meal spikes and stays after dinner.)

I head to sleep with a 91 mg/dl and a small snack in my stomach. I was already coming down from a correction I had made at 9 pm, but my snack made my BG rise to 130 mg/dl, so I gave a conservative injection to cover most of the snack I ate.

Some time during the middle of the night, my fight or flight instinct kicked in and I bounced into the kitchen to check myself. Ah, shoot. Okay – guess I took too much for that snack. I feel – eh – maybe in the high 50s. Extremely hungry. Spots forming in my vision. But, for the most part, coherent enough to test and treat.

BG meter: 28 mg/dl

Me: Wait, what? How am I still standing? Oh… hey, juice now.

Hot damn, really? 28? The sad part about it is that I really didn’t want to eat anything. I had my juice, waited, had a graham cracker, waited, had a small glass of milk because I was really thirsty. Continued to check every 10 minutes and finally felt safe heading to bed with a BG of 72. Woke up at around 6:00 with a 188 mg/dl.

I’m happy I was able to treat. I’m also really happy I was able to function out of bed without the aid of my hubs. (Hasn’t needed to happen yet.) And REALLY happy I didn’t wake up with a morning BG of over 300. (Has happened before.)

So – now I’m trying to figure my culprit. Did I stack too many humalog doses? Did I stack my Lantus? Was it a combo of everything? Was my pancreas really upset that I self-tanned again and this was payback? (No – not really. But at least I would have looked good for the paramedics?)

I’m also just having lows all the damn time now, mostly because I can’t do math and keep track of time. And it’s really rough not having those middle of the night alarms, even though I love to hate them. It’s fine. It’s only a few more days of this madness.

Friday’s Thought: Hypo-Tasking

A PSA.

It’s not wise to try and call your job recruiter back while treating a 58 mg/dl. Generally I function semi coherently while that low. Today, I thought it would be a great idea to drink my iPhone and try to listen to my voicemail on my glass of OJ, thus resulting in a mess on my kitchen floor.

The recruiter didn’t really have much to say so I probably could have just waited to call back. But I’m not one to wait.

Happy Friday I guess.

Swing, Swang, Swung

Wheee!!!

First – a shameless blog note. I officially have 50 followers. Yay! I mean, I know there are others that follow via other means (RSS feeds, etc), but Word Press now says I have 50 via the Word Press feed or via email. So hello all!

I spent my weekend living the swing convention dream by trying to fit in lots of late night dancing, socializing, and competing into 4 days. Half the time was spent corralling my blood sugar control. All efforts proved to be ineffective. Lots of unexplained lows paired with extreme rebounds. (Much like… aha!… a swing.)

This would have been a fantastic weekend to use a CGM… which will apparently be here on Friday. (sigh)

I tried to do a reduced temp basal, but the problem with swing conventions is that it’s not a steady stream of activity to warrant that kind of a reduction. I’ll dance for 15 minutes straight, then stop for another 45 to watch a contest. And then maybe 5 minutes of dancing in between. Since I appear to be way sensitive to basal rates, a 5% reduction sends my sugars into unsafe territory. But – as soon as I correct, I’m hypoglycemic. I went through about 2 full rolls of glucose tabs, a lot of fruit snacks and granola bars. And in a rare moment, I found it necessary to shoot a packet of sugar. Which was disgusting. You just do what you gotta do, I guess.

I did realize that, now that my morning basals are fixed, my breakfast bolus rate is now too high. That’s been reduced to start my week with. (And that sort of worked this morning.)

Also – bacon and eggs taste pretty good at midnight.

Stopping Bad Habits

I failed my basal test early last night. Why? Because about 2.5 hours after I ate, I dropped into the 60s, which leads me to believe that my dinner bolus ratio is still too high.

Or is it?

I have a horrible habit of overriding my pump. I feel that if my blood sugar isn’t under 200 2-3 hours after a meal, I must have seriously miscalculated my previous meal’s insulin intake. So I rage bolus (feverishly administering mathematically-inaccurate amounts of insulin just to make blood sugar readings do something) until I get down to a normal level. Never mind that there may be 2, or 3, or 5 units still working through my system that haven’t done anything yet.Don’t care. I just don’t want to be 289 anymore please, thanks.

Herein lies the problem. Rage bolusing blindly often just stacks insulin against you, resulting in an epic tumble down to no-man’s land and leaves you crawling to your fridge for another glass of orange juice. My doctors and CDE have told me, repeatedly, to stop this practice because it just sets me up for all the lows that I’m diligently trying to avoid. However, when you test every hour for four hours straight with an average of 170, you start to think something isn’t doing it’s job. (Yes – pump air bubbles – I’m blaming you… because who else can I blame?) I have been “conservatively” over correcting in places, rather than just administering an entire correction at will. A unit here… a unit there. If it’s still not enough, another a half hour later.

By the time dinner rolls around, I’m hanging out between 120-140 mg/dl with about 4 units of insulin on board. What possibly could go wrong?????

Oh hey… maybe I should try NOT micromanaging my sugars for an afternoon to see what my dinner blood sugar will actually be around 5:00 pm. Hmm.

Today was an exception. I was treated to a luncheon/learn session by a local PR association, which was catered by one of my favorite restaurants. (And was held in a nightclub I used to frequent when I was 24… weird…) I had a salad of mixed greens and <*goat cheese!!!*>, a half turkey sandwich… and an epically huge brownie. I started the meal at 112 and felt myself falling. Lunch popped me up to nearly 300 and kept me there. all. afternoon. I still haven’t really come down to stay down yet. (But that may have been the veggie pizza I had for dinner…)

BUT – before I headed to dance class at 7:15, just barely an hour after I ate that pizza, I was 116. Maybe all of that insulin I was correcting with finally kicked in. (Only to have the fat in the pizza negate all my progress.)

I should take my own advice. Maybe I’ll have an accurate test here soon. But that involves not having a social life or a need for sleep for three evenings.